Payel Gupta, MD: Choosing the Right Treatment for Patients with Severe Asthma

DECEMBER 03, 2018

MD Magazine Staff

With all the different treatments available for patients with severe asthma, how can physicians choose the one that’s right for their patients? According to Payel Gupta, MD, of ENT & Allergy Associates in Brooklyn, NY, the decision hinges upon an intimate knowledge of type of asthma and an intimate knowledge of the patient.

With our severe asthmatics we're able to figure out what their phenotype is. Are they allergic? Are they allergic and eosinophilic? Are they steroid dependent? Some of those types of asthma tend to overlap.

As allergists now, with all of these different treatment options, we have to figure out which one to pick. There are a lot of products that've just come out for, specifically, eosinophilic asthma and I think as a practicing clinician, it's just about figuring out which one you should choose, and that's the biggest conundrum for all of us.

We talk about that a lot among ourselves. So what are you guys using? What've you had good benefits with? All that kind of stuff.

The one thing with dupilumab is that it's going to be administered at home. That's one kind of bonus point for that treatment option is that patients will actually administer it to themselves at home.

That has its pros and cons. With any kind of patient, you want to know that they're taking their treatments, so having them use an injectable at home, compliance is potentially going to be an issue. Whereas, other options where they have to come into the clinic, you know that they're not showing up, you know that they're not coming in, so you can be on top of them a little bit more.

There are pros and cons. It might be more convenient for more patients to do it at home, but then as a physician, you're worried about their compliance.

I think that some people are talking about whether you can use 2 biologics at once, and that hasn't been studied. There's not going to be a company that's going to pay to study their drug with another drug. So there are certain patients that might fit using something like Xolair and something like Dupixent, so using both of those medications at the same time.

Right now I think it comes down to what the insurance plan might cover. That's my first thing when I have somebody with eosinophilic asthma: let's find out from their insurance what their preferred drug is, and then look at that preferred drug and see if it makes sense for the patient.

Talk to the patient also. Talk to them and figure out what they want. Do they really want something that they can inject at home, do they mind coming into the office? There's also an IV option, and so finding out which option for them feels safer.

It's talking to the patient, looking at insurance coverage, and then kind of going with the other details that we all figure out as we use the medications more and more.